Healthcare Provider Details

I. General information

NPI: 1689128027
Provider Name (Legal Business Name): JOR-REL KINARD L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2016
Last Update Date: 08/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PLEASANT HOME RD SUITE G1
AUGUSTA GA
30907-0518
US

IV. Provider business mailing address

211 PLEASANT HOME RD SUITE G1
AUGUSTA GA
30907-0518
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-4599
  • Fax: 706-364-4589
Mailing address:
  • Phone: 706-364-4599
  • Fax: 706-364-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: